Department of Urology, Keio University School of Medicine, Tokyo, Japan.
Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan.
Ann Surg Oncol. 2021 Sep;28(9):5349-5359. doi: 10.1245/s10434-021-09750-0. Epub 2021 Mar 5.
Our aim is to evaluate whether previous non-urothelial malignant history affects the clinical outcomes of patients with non-muscle invasive bladder cancer (NMIBC).
We identified 1097 cases treated by transurethral resection of bladder tumors for initially diagnosed NMIBC at our four institutions between 1999 and 2017. We compared clinical characteristics and outcomes between NMIBC patients with and without previous non-urothelial malignant history and investigated whether smoking status and treatment modality for previous cancer affected NMIBC outcomes.
A total of 177 patients (16.1%) had previous non-urothelial malignant history (malignant history group). The 5-year recurrence-free survival rate and the 5-year progression-free survival rate in the malignant history group was 46.4% and 88.3%, respectively, which was significantly lower than that in the counterpart (60.2% p = 0.004, and 94.5% p = 0.002, respectively). A multivariate Cox regression analysis identified previous non-urothelial malignant history as an independent risk factor for tumor recurrence (p = 0.001) and stage progression (p = 0.003). In a subgroup of patients who were current smokers (N = 347), previous non-urothelial malignant history was associated with tumor recurrence and stage progression. In contrast, previous non-urothelial malignant history was not associated with tumor recurrence or stage progression in ex-smokers or non-smokers. In a subgroup analysis of NMIBC patients with previous prostate cancer history, those treated with androgen deprivation therapy had a significantly lower bladder tumor recurrence rate than their counterparts (p = 0.027).
Previous history of non-urothelial malignancy may lead to worse clinical outcome in patients with NMIBC, particularly current smokers.
我们旨在评估非尿路上皮恶性病史是否会影响非肌层浸润性膀胱癌（NMIBC）患者的临床结局。
我们在 1999 年至 2017 年间，在我们的四个机构中，共确定了 1097 例接受经尿道膀胱肿瘤切除术治疗的初诊 NMIBC 患者。我们比较了 NMIBC 患者有和无既往非尿路上皮恶性病史的临床特征和结局，并探讨了既往癌症的吸烟状况和治疗方式是否会影响 NMIBC 结局。
共有 177 例（16.1%）患者有既往非尿路上皮恶性病史（恶性病史组）。恶性病史组的 5 年无复发生存率和 5 年无进展生存率分别为 46.4%和 88.3%，显著低于对照组（分别为 60.2%，p = 0.004 和 94.5%，p = 0.002）。多变量 Cox 回归分析确定既往非尿路上皮恶性病史是肿瘤复发（p = 0.001）和疾病进展（p = 0.003）的独立危险因素。在当前吸烟者亚组（N = 347）中，既往非尿路上皮恶性病史与肿瘤复发和疾病进展相关。相反，在既往吸烟或不吸烟的患者中，既往非尿路上皮恶性病史与肿瘤复发或疾病进展无关。在既往前列腺癌病史的 NMIBC 患者亚组分析中，接受雄激素剥夺治疗的患者膀胱癌复发率显著低于对照组（p = 0.027）。
既往非尿路上皮恶性病史可能导致 NMIBC 患者的临床结局更差，尤其是当前吸烟者。
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